Provider Demographics
NPI:1508071689
Name:CROW, TERESA LOUISE (LMP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:CROW
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2282
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-0682
Mailing Address - Country:US
Mailing Address - Phone:509-989-5029
Mailing Address - Fax:
Practice Address - Street 1:310 S BALSAM ST STE B
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1763
Practice Address - Country:US
Practice Address - Phone:509-989-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist